近足月小于胎龄儿与适于胎龄儿早期并发症构成比与预后对比研究

目的对近足月小于胎龄儿与适于胎龄儿的临床资料进行分析评价,探讨其并发症和预后情况。方法收集鹤山市妇幼保健院新生儿科收治的新生儿资料进行回顾性分析研究。按照患儿的胎龄与出生体质量的关系进行分组:A组为适于胎龄儿共62例,B组为近足月小于胎龄儿共87例。对所有纳入分析的患儿出生后的疾病构成比和转归情况进行统计,并同时分析纳入患儿自然分娩或剖宫产对疾病构成及预后的影响。结果近足月小于胎龄儿组的发病率明显高于适于胎龄儿组(P<0.05);低血糖、感染、呼吸窘迫综合征(RDS)、高胆红素血症的发生率剖宫产组明显高于自然分娩组(P<0.05);两组RDS疾病的转归、住院天数比较差异有统计学意义(P<0.05);RDS的治愈率组间比较差异有统计学意义(P<0.05)。自然分娩组近足月儿总住院天数,短于剖宫产组,差异有统计学意义(P<0.05)。结论与适于胎龄儿相比,近足月小于胎龄儿的疾病发病率相对较高,预后相对较差。     

小于胎龄儿生后3月生长激素和胰岛素样生长因子I变化及临床意义

目的通过观察小于胎龄儿(SGA),适于胎龄儿(AGA)生后1 d、1月、3月生长激素(GH)/胰岛素样生长因子I(IGF-I)水平变化,探讨SGA与GH/IGF-I的关系及其临床意义。方法用放射免疫分析法测定了SGA和AGA出生后1 d、1月和3月外周血GH和IGF-I的浓度。结果①SGA出生后1 d与出生后1月和3月的IGF-I水平有明显差异(P<0.05),分别为4.1±1.3 nmol/L、8.7±2.0 nmol/L和9.6±1.9 nmol/L;出生后1月和出生后3月的IGF-I水平相似(P>0.05);②AGA出生后1 d与出生后1月和3月的IGF-I水平无明显差异(P>0.05),分别为9.9±2.3nmol/L、11.2±0.8 nmol/L和10.6±2.1 nmol/L;③SGA和AGA生后1天IGF-I水平具显著性差异,但出生后1月和3月的IGF-I水平无明显差别;④出生时SGA组和AGA组的GH水平有显著性差异(P<0.05);出生时SGA组GH的水平低于出生后1月和3月的GH水平(P<0.05);出生后1月和3月的SGA组的GH水平低于AGA组,但是没有统计学差异(P>0.05)。结论SGA存在着一过性低IGF-I和GH水平,低IGF-I和GH水平可能是SGA的发病原因之一。     

小于胎龄儿Ghrelin水平与生长追赶的关系探讨

目的:探讨生长激素释放肽(Ghrelin)与小于胎龄儿(SGA)生长追赶的关系.方法:选择SGA和适于胎龄儿(AGA)各30例,分别于出生后3d、1个月及1岁时测量生长发育指标及检测血浆Ghrelin值.结果:SGA组在出生后3d及1个月时的体质量、身长、头固、BMI水平均明显低于AGA组(P均＜0.05);1岁时SGA组的体质量、头围、BMI水平与AGA组比较差异无统计学意义(P＞0.05),但身长仍低于AGA组(P＜0.05).SGA组在出生后3d及1个月时的血浆Ghrelin水平高于AGA组,1岁时两组Ghrelin水平比较差异无统计学意义(P＞0.05).SGA组在出生后3d及1岁时血浆Ghrelin水平与体质量呈负相关,AGA组在3个时间点上Ghrelin水平均与体质量呈负相关.结论:SGA在出生后头1年存在明显的生长追赶.SGA出生时的高Ghrelin水平,反映了胎儿在宫内的不良营养状态.其追赶生长与体内的高水平Ghrelin密切相关.     

小于胎龄儿生后3月生长激素和胰岛素样生长因子I变化及临床意义

小于胎龄儿(newborns sm all for gestational age,SGA)是出生体重低于同胎龄正常值的第10百分位数或低于同胎龄正常平均值的2个标准差的一组新生儿,在我国发生率达7.5%,病死率是正常足月儿的8倍[1]。本研究旨在分析小于胎龄儿与适于胎龄儿(newborns appropriate for gestation     

小于胎龄儿脑影像学的研究

小于胎龄儿脑影像学的研究张伟利，吴圣楣，李小英，陈冠仪小于胎龄儿（Ｓｍａｌｌｇｅｓｔａｔｉｏｎａｌａｇｅ，ＳＧＡ）出生时其出生体重明显低于正常新生儿，易发生各种围产期并发症，死亡率较高，而且出生后体格及智力发育也常受影响。为了观察ＳＧＡ出生后脑的发育...     

印记基因与小于胎龄儿研究进展

基因组印记是令一对等位基因仅表达父源或母源基因的一种表观遗传性修饰, 多在胎盘中存在, 对胎盘和胚胎发育至关重要。在对小于胎龄儿发病机制的研究中, 印记基因是不可缺少的一部分。但相关研究争议很大, 尚未得出统一的结论。本文就近些年印记基因与小于胎龄儿的研究予以综述。     

小于胎龄儿尿微量蛋白检测和临床意义

目的 通过检测小于胎龄儿尿微量蛋白（SGA）和血BUN、Cr的变化探讨尿微量蛋白在宫内发育迟缓新生儿肾脏损害早期诊断的意义.方法 小于胎龄儿组新生儿40例（足月小样儿组20例,早产小样儿组20例）,对照组分别为40例足月适于胎龄儿、30例早产适于胎龄儿,于生后48h内留取新鲜尿液检测尿微量蛋白：尿α1微球蛋白（α1-MG）、β2微球蛋白（β2-MG）、N-乙酰-β- D-氨基葡萄糖苷酸酶（NAG）、转铁蛋白（TRF）、免疫球蛋白（IgG）;采静脉血检测血BUN、Cr.结果 足月小样儿组与足月适于胎龄儿组比较：尿α1-MG、β2-MG、NAG水平升高,差异有统计学意义（P〈 0.01）;尿TRF、IgG 、血BUN、Cr水平无明显统计学差异（P〉0.05）.早产小样儿组与早产适于胎龄儿组比较：尿α1-MG、β2-MG、NAG、TRF、IgG 、血BUN、Cr水平均显著升高（P〈 0.01）.足月小样儿组与早产小样儿组比较：尿α1-MG、β2-MG、NAG水平均无明显统计学差异（P〉0.05）,尿TRF、IgG和血BUN、Cr水平显著升高（P〈0.01）.结论 小于胎龄儿尿微量蛋白水平有明显变化,可以作为新生儿宫内发育不良肾脏损害早期的判断指标.     

不同胎龄、出生体重新生儿血清甲状腺激素水平的变化

目的探讨新生儿血清甲状腺激素水平与胎龄、出生体重的关系。方法用化学发光免疫分析法测定不同胎龄、出生体重新生儿血清T3、T4、TSH水平,分别按胎龄和出生体重进行分组比较,并对胎龄、出生体重与甲状腺激素(T3、T4、TSH)行相关性分析。结果随着胎龄、出生体重的增加,新生儿血清T3、T4水平升高(P0.05),TSH无显著性差异(P0.05);新生儿胎龄、出生体重与血清T3、T4水平亦呈正相关(P0.05),而与血清TSH水平无相关性(P0.05)。结论胎龄越小或出生体重越低,血清T3、T4水平越低,而TSH基本正常。新生儿血清T3、T4水平与胎龄及出生体重呈显著正相关。     

晚期早产儿中小于胎龄儿的临床特点分析

选取我院住院晚期早产儿750例,其中,96例SGA患儿作为SGA组,635例适于胎龄儿作为AGA组,19例大于胎龄儿因病例数较少排除。比较两组的围生期因素以及患病情况。结果 SGA组的出生体重显著低于AGA组,住院时间显著延长(P<0.05);SGA组的母亲妊高征、脐带异常、羊水过少、多胎妊娠以及宫内窘迫发生率均显著高于AGA组(P<0.05);SGA组的喂养不耐受、败血症、低血糖及红细胞增多症发生率均显著高于AGA组(P<0.05)。母亲妊高征、多胎妊娠以及脐带异常均是引发晚期早产儿SGA的危险因素,且SGA患儿的围生期患病风险较AGA患儿显著提高,加强围生期管理与新生儿疾病防治非常必要。     

妊娠期糖尿病产妇脐血胰岛素及脂联素与新生儿结局的相关性研究进展

妊娠期糖尿病(GDM)的发生与胰岛素抵抗和胰岛素分泌受损有关,胰岛素抵抗是一个亚临床炎症过程,胰岛素及脂联素在这个过程中与其他炎症因子共同作用。收集近年来对GDM产妇脐血胰岛素、脂联素及对GDM孕妇所生新生儿预后影响的相关的研究文献,对它们之间的相关性进行探讨,为临床的诊断、治疗和改善新生儿预后提供参考。     

足月新生儿早期行为神经评分与出生体质量及胎龄的相关性

目的了解足月新生儿早期行为神经发育水平,探讨行为神经评分与出生体质量及胎龄的相关性。方法 2012年5-9月,采用便利抽样法选取莆田学院附属医院妇产科出生的单胎正常足月儿93例,采用新生儿20项行为神经测定(neonatal behavior neurological assessment,NBNA)法于新生儿出生后48~72h分别检测25例小于胎龄新生儿(small for gestational age,SGA)、35例适于胎龄新生儿(appropriate for gestational age,AGA)和31例大于胎龄新生儿(large for gestational age,LGA)的行为神经能力。结果与AGA组相比,SGA组、LGA组新生儿的NBNA总分、行为能力、主动肌张力、一般反应、对格格声反应、对说话人的反应、红球反应、牵拉反射、活动度评分等均明显降低(P0.05);SGA组新生儿NBNA各项目评分与出生体质量及胎龄呈正相关,而LGA组新生儿NBNA各项目评分则与出生体质量及胎龄呈负相关。结论新生儿早期行为神经评分与出生体质量及胎龄相关;应加强孕妇的孕期保健以减少SGA及LGA的发生,对早期发现有行为神经轻微异常的新生儿,应及早进行干预,以促进其行为神经的正常发育。     

Influence of Gestational Age, Cesarean Section and Hematocrit on lnterleukin-8 Concentrations in Plasma and Detergent-Lysed Whole Blood of Noninfected Newborns

SUMMARY: BACKGROUND: Sensitivity of interleukin-8 (IL-8) in detecting early-onset bacterial infection (EOBI) is high. A high percentage is bound to nonspecific receptors on erythrocytes which can be determined via cell lysis. We have shown detergent-lysed whole blood (DLWB) IL-8 to be superior to plasma IL-8 in detecting EOBI. METHODS: To evaluate influence of pre- and perinatal factors on plasma and DLWB IL-8 concentrations, IL-8 was determined via ELISA (Immu-lite) in 146 noninfected newborns with risk factors for EOBI at two different time periods: 0-6 (group I) and 24-30 h (group II) after birth. The influence of gender, mode of delivery, gestational age and hematocrit was evaluated. RESULTS: While we found no influence of gender or gestational age, hematocrit was positively correlated with IL-8 plasma concentration (group I: r = 0.33, p < 0.001; group II: r = 0.30, p <0.01). IL-8 plasma concentrations after primary versus secondary cesarean section were lower (p < 0.05). Gestational age was correlated with DLWB IL-8 concentrations (group I: r = 0.46, p < 0.001; group II: r = 0.28, p < 0.001). CONCLUSION: Plasma IL-8 concentrations were positively correlated with hematocrit, whereas DLWB IL-8 concentrations increased with gestational age. This may be relevant to the interpretation of IL-8 in preterm infants and infants with anemia, polyglobulia or hematolytic diseases.     

Umbilical Artery Doppler Indices in Small for Gestational Age Fetuses

Objective. The purpose of this study was to compare the screening efficiency of the umbilical artery systolic to diastolic ratio (S/D), pulsatility index (PI), and absent end-diastolic flow (AEDF) for adverse pregnancy outcomes and placental abnormalities in small for gestational age (SGA) fetuses. Methods. We conducted a retrospective cohort study of Doppler examinations of 161 nonanomalous SGA fetuses. The reliability of the S/D and PI were quantified by intraclass correlation coefficients. The association of the S/D, PI, and AEDF with adverse outcomes and placental abnormalities was compared by the χ² test. Results. There was a simple association of Doppler results with adverse outcomes, which was mitigated when controlled for gestational age. For all measures of adverse outcomes, the specificity of abnormal Doppler results exceeded the sensitivity, and the negative predictive value was greater than the positive predictive value. Comparing the S/D with the PI, there was no significant difference in the sensitivity; however, the specificity of the PI was at least 90% and exceeded that of the S/D for all outcomes. The intraclass correlation coefficients of the S/D and PI were similar, indicating no difference in reliability. Placental abnormalities were significantly more common in cases with abnormal Doppler values (positive predictive value, 94%) with no overlap in the types of placental lesions in most cases. Conclusions. As an initial screen for adverse outcomes in SGA fetuses, the umbilical artery Doppler S/D, PI, and AEDF were imprecise. However, these measures were all strongly and similarly predictive of placental abnormalities, especially lesions of maternal underperfusion and fetal vascular obstruction.     

妊娠期糖尿病患者的血糖、血脂、血尿酸及胰岛素敏感性变化

目的：探讨妊娠期糖尿病（GDM）患者与胰岛素抵抗综合征（IRS）的关系。方法：测定130例GDM患者（GDM组）及125例正常孕妇（对照组）的空腹血浆葡萄糖（GLU）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、血尿酸（UA）、胰岛素（FINS）水平,计算胰岛素敏感指数（ISI）,两组比较。结果：校正孕妇年龄、孕龄、孕前体重和孕前体重指数（BMI）等因素后,GDM组100 g葡萄糖耐量试验各个时点血糖值均比对照组高,差异有显著性（P〈0.01）;GDM组的TC、TG、LDL-C、UA、FINS、ISI值均比对照组高,差异有显著性（P〈0.01）,而HDL-C值则比对照组低,差异也有显著性。结论：GDM孕妇的血糖、血脂、血尿酸及胰岛素水平均比正常孕妇高,而胰岛素敏感性则比正常孕妇低,存在更严重的胰岛素抵抗（IR）。GDM是IRS在妊娠期的一种特殊表现。     

ELISA检测新生儿脐带血S100B蛋白

目的了解新生儿S100B蛋白水平.方法用双抗体夹心ELISA法检测了45名正常足月新生儿脐带血S100蛋白含量.结果正常足月新生儿脐血S100B为1.19±0.16 μg/L,参考范围0.88～1.50μg/L,男女性别无显著性差异.结论新生儿脐血S100B与脑成熟有关.     

Prothrombotic State, Cardiovascular, and Metabolic Syndrome Risk Factors in Prepubertal Children Born Large for Gestational Age

OBJECTIVE

To evaluate metabolic syndrome and cardiovascular disease risk factors in prepubertal children born large for gestational age (LGA) to nondiabetic, nonobese mothers.

RESEARCH DESIGN AND METHODS

At 6–7 years of age, the comparison of various factors was made between 31 LGA and 34 appropriate-for-gestational-age (AGA) children: fibrinogen, antithrombin III, protein C and S, fasting insulin, glucose, homeostasis assessment model of insulin resistance (HOMA-IR) index, adiponectin, leptin, visfatin, IGF-1, IGF-binding protein (IGFBP)-1, IGFBP-3, lipids, and the genetic factors V Leiden G1691A mutation, prothrombin 20210A/G polymorphism, and mutation in the enzyme 5,10-methylenetetrahydrofolate-reductase gene (MTHFR-C677T).

RESULTS

LGA children had higher levels of leptin (P < 0.01), fasting insulin (P < 0.01), and HOMA-IR (P < 0.01), but lower IGFBP-3 (P = 0.0001), fibrinogen (P = 0.0001), and lipoprotein(a) (P < 0.001) than AGA children. Significantly more LGA children were homozygous for the MTHFR-C677T mutation (P = 0.0016).

CONCLUSIONS

Being born LGA to nondiabetic, nonobese mothers is associated with diverse effects on cardiometabolic risk factors at prepuberty.Large-for-gestational-age (LGA) infants may be at risk for the development of obesity and insulin resistance (1–4). A relationship between excess birth weight and metabolic syndrome (MetS) and cardiovascular disease (CVD) risk factors (1–4) has not yet been clearly demonstrated.The aim of this study was to evaluate markers of the prothrombotic state and other MetS and CVD risk factors in prepubertal children born LGA to nondiabetic, nonobese mothers.